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LESLIE JAY SUGA PHD HSPP

Clinical Neuropsychologist

Indianapolis, Indiana

Provider NPI: 1972595684

Provider Information:
 LESLIE JAY SUGA PHD HSPP
Gender: M
Not Sole Proprietor

Practice Location:
6515 E 82ND ST SUITE 210 INDIANAPOLIS, IN 46250 US
Tel: 317-559-0990  Fax: 317-653-6405

Business Mailing Address:
8539 TIDEWATER DR  INDIANAPOLIS, IN 46236 US
Tel: --  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IN20040349A

Other Provider Identifiers:

IssuerNumberStateType
100376990AIN05
MEDICARE RAILROAD680013641IN01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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